Health Literacy in Inflammatory Bowel Disease: A Systematic Review of Health Outcomes, Predictors and Barriers.

Background/Objectives: Inflammatory bowel disease (IBD), including Crohn's Disease and Ulcerative Colitis, requires complex treatment and active patient participation. Health literacy (HL), defined as the ability to access, understand, and apply health information, is a key factor influencing adherence, self-management, and quality of life in chronic illness. However, evidence regarding HL in IBD remains limited and fragmented. This systematic review aimed to synthesize existing literature on HL in IBD, exploring its impact on outcomes, as well as its predictors and barriers. Methods: A systematic search of PubMed, Scopus, CINAHL, and Cochrane Library identified studies published between January 2000 and August 2025 in English or Italian. Eligible studies examined HL among adults with IBD and its associations with clinical, behavioral, or psychosocial outcomes. Methodological quality was assessed using the QuADS tool. Due to heterogeneity across studies, a narrative synthesis was conducted. Results: Seventy studies were included, comprising observational, qualitative, mixed-methods, and interventional designs. Higher HL was consistently associated with better treatment adherence, self-management, communication with healthcare providers, and quality of life. Conversely, low HL was linked to poor adherence, greater disease activity, and lower psychological well-being. Predictors of low HL included older age, lower education, minority status, and socioeconomic disadvantage. Barriers included inadequate communication, lack of tailored information, cultural and linguistic challenges, and the digital divide. Interventions such as structured education, telemedicine, and digital tools showed potential to improve HL and patient engagement. Conclusions: HL is a crucial determinant in IBD management. Enhancing HL through integrated clinical, educational, and digital strategies is essential to improve outcomes and reduce health disparities.